The Comeback Of Polio Is A Public Health Emergency

On the outskirts of Islamabad, a Pakistani health worker vaccinates an Afghan refugee against polio.

Muhammed Muheisen
/ AP

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Originally published on May 6, 2014 4:25 pm

It is, says the World Health Organization, "an extraordinary event." Polio is spreading to a degree that constitutes a public health emergency.

The global drive to wipe out the virus had driven the number of polio cases down from 300,000 in the late 1980s to just 417 cases last year. The World Health Organization has set a goal of wiping out polio by 2018.

But this year, polio has been reported in 10 countries, and there are fears the number could rise. Bruce Aylward, the head of WHO's polio program, says if the international spread isn't halted, the virus could easily re-establish itself, particularly in conflict-torn countries like the Central African Republic and South Sudan. The unrest makes it difficult to sustain vaccination efforts, and poor sanitary conditions cause the disease to spread.

Although polio mainly afflicts children under 6, a WHO emergency committee has stated that adults are to blame. The committee noted that there is "increasing evidence that adult travelers [from Pakistan, Syria and Cameroon] contributed" to the polio surge.

As a result, the World Health Organization has taken the unusual step of ordering these three countries to vaccinate any resident who travels internationally. In addition, WHO is calling for the three countries to continue efforts to inoculate their children. The mandate was issued by the director-general's Emergency Committee on International Health Regulations.

Aylward says this focus on travelers is critical to stem the virus, which causes paralysis and can be fatal.

"The Pakistan virus has been reported from Israel, from Iraq, from Syria, and was also found at one point in the sewage in the West Bank and Gaza," Aylward says.

Polio virus that was genetically linked to Pakistan also turned up in Cairo last year and caused an outbreak in China in 2011.

The new WHO rules require Pakistan, Syria and Cameroon to vaccinate all international travelers at least four weeks prior to departure. Travelers from these countries will have to carry proof of vaccination.

This program could prove difficult to implement in Syria, given the chaos of the civil war and the almost 9 million Syrians displaced from their homes. But Aylward is optimistic.

"I believe it's very much possible," he says, "if not four to 12 weeks prior to travel — because a lot of travel there right now is, as everyone knows, quite unpredictable and on very short notice — certainly at point of departure."

India instituted similar requirements for travelers in March and added one more: Visitors from a country with ongoing polio cases must be vaccinated six weeks prior to entering India.

Naveen Thacker, who has worked on India's polio eradication effort for more than two decades, says the new WHO rules do more than just stop an individual traveler from unknowingly spreading the virus stowed away in his gut.

"It's a very welcome step because it builds a sense of urgency in these countries," he says. "I remember India was one of the last countries [with smallpox]. And our then-prime minister, Mrs. Indira Gandhi, just telling the nation, this is a matter of our pride, and then the whole nation followed."

WHO hopes the new requirements will help isolate the virus and keep efforts on track to have a polio-free world in another four years.

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MELISSA BLOCK, HOST:

And I'm Melissa Block. The World Health Organization is ordering several countries to take new steps to stop polio. Officials at the WHO are concerned about polio outbreaks in Pakistan, Syria and Cameroon. They threaten to undermine the entire global polio eradication program. We have more from NPR's Jason Beaubien.

JASON BEAUBIEN, BYLINE: Many countries have been polio free for decades - mass vaccination programs wiped the virus out. But now, some of those disease-free countries are being re-infected. And the WHO says international air travel is the problem. So, today, in an unusual move, the WHO declared polio a public health emergency of international concern. This allows the WHO to order Pakistan, Syria and Cameroon to vaccinate all residents before they're allowed to travel internationally. They're focusing on these three countries because the WHO has been able to show, through genetic sequencing, that these are the only countries exporting the virus.

BRUCE AYLWARD: The Pakistan virus has been reported from Israel, from Iraq, from Syria. It was also found at one point in the sewage in the West Bank and Gaza.

BEAUBIEN: Bruce Aylward is the head of the WHO's polio program. The Pakistan virus also turned up in Cairo last year and caused an outbreak in China in 2011. The new WHO requirements call for Pakistan, Cameroon and Syria to vaccinate all international travelers at least four weeks prior to departure. Travelers would also have to carry proof of polio vaccination. This whole program might seem quite difficult in Syria, given the chaos of the current civil war, but Aylward says it's still doable.

AYLWARD: Yeah, I believe it's very much possible. If not 4 to 6 weeks prior to travel, because a lot of travel there right now, as everyone knows, quite unpredictable and on very short notice, certainly at point of departure.

BEAUBIEN: He says vaccinating people as they flow across the border is not ideal but it's better than nothing. Right now, 10 countries are reporting polio cases so far this year. Aylward says if the international spread isn't halted, the virus could establish itself in other war-torn countries, such as the Central African Republic or South Sudan. Over the last 25 years, the global eradication effort has driven the number of polio cases down from roughly 300,000 in the late 1980s to just 417 cases last year anywhere in the world. The WHO has set a goal of completely wiping out polio by 2018. Independent of today's emergency declaration, India put in similar polio vaccination requirements on travelers in March. India, which only got rid of the virus in 2011, now requires visitors from any country with polio cases to be vaccinated six weeks prior to entering India. The WHO hopes the new polio travel requirements will help isolate the virus and ultimately lead to its demise. The burden of putting these new travel rules in place falls to Pakistan, Syria and Cameroon. Jason Beaubien, NPR News, Washington. Transcript provided by NPR, Copyright NPR.